How You Can Keep Kids Safe by Dr. Eichelberger

I have been a pediatric surgeon for over 35 years and have dedicated my life to saving the lives of injured children. Even though my surgical work is focused on saving kids once they are injured, I realized early on what an impact prevention and safety could make in the staggering number of injured children we saw each year. 

After years of treating these kids, I felt compelled to act and founded the National SAFE KIDS Campaign with Herta Feeley in 1987, which became Safe Kids Worldwide in 2005. Through research and data gathering, we learned over the years that kids of different age groups are primarily injured in certain ways that can be tracked, assessed and impacted with increased prevention tactics. Toddlers and young children have a higher occurrence of injuries from falls, while adolescents have higher incidence of injuries in motor vehicles because they're drivers now. We have to be careful in making sure that we're talking about the right group before we go thinking about prevention because sometimes prevention is not as relevant. 

I think that the approach to injury really focuses in on our communities because people ask themselves, “What can I do?” Believe it or not, there’s a lot you can do.  My lifelong quest to prevent childhood injuries has led to increased research, improved safety measures and significant change in awareness of child safety issues. You can find many valuable tips and life-saving advice at SafeKids.org, and other great prevention and safety websites. 

My daughter has three kids, and earlier this year I spent four days chasing them around, and I can tell you it’s a real challenge to keep kids safe. They are quick and inquisitive, all the things that you want kids to be. The problem is they put themselves in harms’ way and it’s our job to protect them from getting hurt, while allowing them to have fun. It’s a fine line between too much and too little.  

While visiting my daughter, I saw a man riding a bicycle who was approximately 220 pounds, and sitting in front of him on the handlebar was a 4-year-old that couldn’t have been more than 40 pounds. They’re riding this bicycle in a well-populated city in the United States. I asked my son-in-law, “Who is that? That is crazy because if they fall that child’s going to get crushed, and he shouldn’t be riding on the handlebars.” He responded, “Well, that’s our local pediatrician.” I was astonished. This person should not only be more informed than anyone else, but he should be sharing safety messages with all his patients and their parents while setting a good example to anyone that sees him in public.

There are a lot of people that are uninformed about ways to protect kids. Many people don’t see how they are responsible for the effects of an injury. That’s where the community steps in and assumes some responsibility through updated laws and state guidelines for care. Without these initiatives, such as simple helmet laws for children, we end up with millions of dollars in additional healthcare expenses and children that will never make an impact in our society.

As a surgeon, a parent and a grandparent, there are so many things we can do to make sure our kids live in a safer world. We’ve made tremendous progress in prevention over the last 25-30 years, but we still have children suffering needlessly from severe injuries. There are still 10,000 children dying every year from injuries and almost 200,000 children that are hospitalized each year because of injuries. There is plenty of room for improvement in all areas. Our society can make a bigger impact for saving injured kids.

In my experience treating injured children, most parents ask, “Why did this have to happen to my child?” and, “What could I have done to prevent this from happening?” These tough questions don’t have answers that comfort us, but the secret to saving many children is to ask some of these hard questions before the injuries occur.

- Martin R. Eichelberger, M.D., Professor of Surgery and of Pediatrics, George Washington University Children’s National Medical Center, Washington D.C.

 

Saving Kids Worldwide

One of the leading causes of death worldwide is injury to children, especially between 1-14 years of age. Most people are unaware that injury should be considered a disease. There is so much awareness of the benefits of immunization to prevent childhood disease but injury continues unabated. Action to prevent injury and death will save the lives of children and reduce the disability that results.

Worldwide, the challenge is the “burden of injury” which creates a significant economic and social impact upon the family, community and society. The effect upon the family is significant: absence of the child from school, loss of employment by the parent, reduction in income for the family who must care for the child and isolation of the family from the community. After a child steps upon a landmine or plays with unexploded ordinance, the mobility of the child is eliminated after an amputation of an extremity. In many cultures the family is shunned by the community. The “burden” affects the entire community that is responsible to provide a safe environment for the child. Surgeons can prevent death, improve the quality of life and provide a chance for rehabilitation following disability from injury.

Nevertheless, about 10% of the injuries to children worldwide challenge the best surgeons and health care systems. We rely upon a team of people to help save children once they are injured. It takes a system that includes response at the point of injury, acute treatment and a commitment to rehabilitation, to prevent the death of the child and restore them to health. The initial response time has impact upon the outcome. It is imperative that we prepare the first responder and the Emergency Medical System to save the life of the child and to provide transfer to an appropriate level of trauma care.

Sudden events that result in injuries, such as earthquakes, riots or political conflicts, create a challenge for all levels of the system. It takes a long time before you have a response by emergency services, so the bystander and local team need to be able to initiate emergency care while providing transfer to a facility for acute treatment. In the United States, only 10% of injured children have access to a verified pediatric trauma center, so that means 90% receive acute care in general hospital facilities.

The big question is “how do we take care of these kids no matter where they are in the world?” After 10 years of war in Iraq and Afghanistan, the approach to care for the injured child changed. This knowledge and experience affects the system of care and the approach to treatment that makes a difference to children. Better prevention, acute care and rehabilitation will improve the quality of life for the community.

A community has the opportunity to learn from the global experience with injury or to share them with colleagues throughout the world. The convenience and accessibility of using web-based technology can share life-saving ideas quickly. We now can provide access to new surgical techniques and to accelerate practical application in a matter of weeks, instead of years. As an example, The Childress Institute for Pediatric Trauma creates web symposia to provide cutting-edge practice to medical professionals in 33 countries over the past two years.

The timely transfer of pediatric trauma care knowledge is saving the lives of injured children worldwide. The challenge to provide contemporary trauma care to the worldwide community is worthy of our efforts. 

- MartinR. Eichelberger, M.D., Professor of Surgery and of Pediatrics at George Washington University, Children’s National Medical Center in Washington D.C.

Blast Injury by Dr. Eichelberger

*Please note that some links may lead to graphic information not suitable for all audiences.

The Fourth of July inspires celebration - sometimes fireworks, bonfires and other fun activities can lead to serious injuries. This can be even scarier when children are involved. While thinking about "bombs bursting in air" and all of the week's news from war-torn countries, we turn our attention to an issue that is prevalent around the world, and unfortunately hit close to home last year in Boston.

Injury is the number one killer of kids in America and kills many worldwide. Unfortunately, over the last 10 years, children around the world are not just being injured by vehicles or gunfire or falls, but they are actually sustaining injury from explosion, a blast injury. This injury is rare in the United States, but the episode at the Boston Marathon bombings reveals that a new mechanism of injury can occur.  

The explosion creates a pressure wave that results in a blast injury. The most common and dangerous devices are land mines, unexploded devices or “improvised” explosive devices (IEDs), otherwise known as a roadside bomb. In a war-torn country, many of the bombs don’t explode upon impact. These devices have blue, yellow and red tags and children play with the tags, sometimes pulling the pin that detonates the device. These kids become victims of an explosion that result in a unique injury. 

In countries that are experiencing a civil war, such as Colombia, India, Chile, Iraq and Afghanistan, there are millions of “active” land mines. Even when enemies are not fighting, these devices are buried waiting to go off. Innocent children are out there walking and playing where it's easy for them to step upon a land mine.  

Historically, war creates the opportunity to learn new medical techniques and approaches to treatment of the injured patient, which is applicable to the adult patient and to children. When American and other military medical personnel are in these areas, they treat the children as well as the soldiers. Their experience and treatment techniques learned in the field are extremely valuable in saving children around the world. This process is going on right now! For example, in trauma centers we are changing the way we resuscitate pediatric patients with a new concept known as damage control resuscitation. We realize that when a child develops severe shock due to a critical injury, they do much better when we reduce the amount of crystalloid fluid typically given to these kids and instead, immediately treat hemorrhage with infusion of blood products. This approach is more focused upon the importance of coagulation of circulating blood to the survival of the child. Quickly sharing this information saves lives - Sami is an example.

Most American civilian surgeons know little about the effects of a blast from an explosion. Military surgeons who have treated a significant number of children with a blast injury are able to transfer the knowledge to their civilian colleagues to improve the capacity to care for children. A blast pattern is something that most surgeons in the U.S. will never see until there is a devastating emergency. That is one of the reasons we developed the web-based, Childress Pediatric Trauma Symposium and held three of them in the last two years. Our hope is to share knowledge and experiences with our colleagues around the world in time to save lives.

The Boston Marathon bombing is a critical example of why we need to know how to treat a child following a blast injury. If we can share techniques developed to treat children, we can save the lives of children worldwide.

Martin R.Eichelberger, M.D., Professor of Surgery and of Pediatrics, George Washington University, Children’s NationalMedical Center, Washington D.C.